ODS 836 Oral Pathology II - Vesiculo-Bullous Diseases

Study Notes

Herpes Simplex Virus (HSV):
- HSV-1: Causes primary herpetic gingivostomatitis, secondary herpes, and herpetic whitlow.
- HSV-2: Primarily causes genital herpes but can occasionally cause oral infections.
Varicella Zoster Virus (VZV):
- Causes chickenpox (varicella) and shingles (herpes zoster).
Coxsackievirus:
- Causes hand, foot, and mouth disease and herpangina.
Measles:
- Not classified as a vesiculo-bullous disease.

Pemphigus Vulgaris: An autoimmune blistering disorder affecting oral mucosa.
Cicatricial Pemphigoid: Another autoimmune condition causing vesicular lesions.
Bullous Pemphigoid: Characterized by large blister formation, primarily in elderly patients.
Dermatitis Herpetiformis: Linked to gluten sensitivity; presents with vesicular lesions.
Linear IgA Disease: Characterized by linear deposits of IgA at the basement membrane.
Epidermolysis Bullosa Acquisita: A rare autoimmune blistering disorder.

Primary Infection:
- Mostly affects children; presents as acute herpetic gingivostomatitis.
- Symptoms include vesicular eruptions, painful gingivitis, fever, and lymphadenopathy.
- Healing occurs without scarring in 7-10 days.
Secondary Infection:
- Occurs in about 15-45% of the population, usually follows a prodromal phase of tingling or burning.
- Vesicles appear and may progress to ulcers, primarily affecting perioral areas.
- Typically self-limited, with healing in two weeks.

Diagnosis of primary herpes can be based on clinical features, while viral culture or cytology may be used for confirmation.
Differential diagnoses include aphthous stomatitis, streptococcal pharyngitis, and other vesiculo-bullous diseases.

Primary Herpetic Stomatitis:
- Treatment includes hydration, rest, and systemic antivirals like acyclovir within 72 hours of symptom onset.
Secondary Herpes:
- Treatment primarily involves topical antivirals like acyclovir cream, though effectiveness is limited.

Primary Infection (Varicella):
- Transmission through airborne droplets; incubation of about two weeks.
- Symptoms include fever, malaise, pruritic rash with vesicles on the face, trunk, and extremities.
- Recovery typically occurs within 2-3 weeks; complications can include pneumonia and encephalitis.
Oral Lesions:
- Occur at the vermilion border, palate, and buccal mucosa as vesicles and ulcers.
Secondary Infection (Herpes Zoster):
- Reactivation of latent VZV, with painful vesicular eruptions along affected nerve pathways.
- May lead to complications like postherpetic neuralgia and Ramsay Hunt syndrome.

Caused by Coxsackie virus; prevalent in children during summer and early fall.
Symptoms: mild to moderate fever, sore throat, vesicles, and ulcers on the soft palate and tonsils.
Typically self-limiting, diagnosis is clinical.

Caused by measles virus, transmitted through airborne droplets.
Symptoms involve a characteristic triad of cough, conjunctivitis, and coryza, followed by a maculopapular rash.
Complications can include pneumonia and encephalitis, with a notable infectious period before and after rash appearance.